Causes and outcomes of hospitalization in Lewy body dementia: A retrospective cohort study
Introduction
Lewy body dementia (LBD) – the second most common neurodegenerative dementia following Alzheimer disease (AD) – consists of dementia with Lewy bodies and Parkinson disease (PD) dementia. Lack of data regarding hospitalization is a known knowledge gap [1]. Emergency room visits are common: in a survey of caregivers of individuals with LBD, 64% reported a crisis in the prior year and they sought help in a hospital emergency room 73% of the time [2].
Individuals with LBD, frontotemporal dementia, and unspecified dementia are at a higher risk of hospitalization than individuals with AD, vascular dementia, or mixed dementia, likely because neuropsychiatric symptoms are the main predictor of dementia hospital admissions [3]. Hospital admission rates are significantly higher for individuals with dementia with Lewy bodies compared to AD and a catchment population [4]. Individuals with dementia with Lewy bodies have longer hospital stays than those with AD [[4], [5], [6]] and overall higher costs of care [4,7]. In one study, the most common reason for admission for individuals with “parkinsonism-related dementia” was acute delirium (41%), followed by pneumonia (20%), stroke (19%), urinary tract infection (UTI) (7%), and fall-related hip fracture (3%) [6]. In another study, the most common hospital discharge diagnoses for individuals with dementia with Lewy bodies were infections (23%), falls (7%), circulatory illness (7%), dementia (6%), and senility/disorientation (5%) [4].
While little is known regarding hospital outcomes in LBD, hospitalization in PD is a known source of worsened function [8]. Hospitalization of individuals with AD is associated with increased risks of death and institutionalization, with hospital delirium associated with even higher risks of death, institutionalization, and cognitive decline [9]. Multiple studies show that individuals with AD experiencing delirium – often in the context of hospitalization – subsequently have faster cognitive progression [[9], [10], [11]] beyond what can be attributed to the pathology itself [12]. Given that over 40% of hospitalized individuals with dementia receive antipsychotics [13] and the morbidity and mortality associated with antipsychotic use in LBD [14,15], occurrence of hospital delirium in LBD likely carries additional risks of antipsychotic-induced complications.
To address knowledge gaps regarding LBD and hospitalization, we performed a retrospective cohort study to identify common causes, complications, medication profiles, and outcomes of hospitalization for individuals with LBD.
Section snippets
Study design
A retrospective cohort study investigated the causes, experiences, and outcomes of individuals with LBD hospitalized at an academic medical center over a two-year period (1/1/2014–12/31/2015). After institutional review board approval for the chart review (IRB201600391), an honest broker queried records for any hospitalization in the 2-year period including a diagnosis code for LBD (ICD-9 331.82, ICD-10 G31.83) in the admitting diagnoses or on the inpatient problem list.
During chart review,
Demographic and clinical characteristics of participants
The search identified 178 hospitalizations meeting criteria representing 117 individual patients (Table 1). No record demonstrated evidence of a parkinsonism other than LBD. Of the 178 hospitalizations, 125 included diagnosis codes for Parkinson's disease (ICD-9 332.0 or ICD-10 G20) in addition to the codes used to identify individuals with LBD (ICD-9 331.82, ICD-10 G31.83). Eighty-one individuals had a single admission in the 2-year period and 36 individuals had multiple admissions (Table 1).
Discussion
This retrospective cohort study identified that hallucinations and confusion were the most common reasons for hospitalization for individuals with LBD, followed by falls and infection. Most patients (88%) were hospitalized on inpatient teams other than neurology and did not receive neurology or psychiatry consultations. Antipsychotic medications were administered during 38% of hospitalizations and these were new prescriptions or increased doses in 19% of hospitalizations. While quetiapine was
Funding sources
Lewy body dementia research at the University of Florida is supported by the University of Florida Dorothy Mangurian Headquarters for Lewy Body Dementia and the Raymond E. Kassar Research Fund for Lewy Body Dementia.
Author roles
CCS: Acquisition of data, analysis and interpretation of data, drafting and revising the article, final approval; AB: acquisition of data, analysis and interpretation of data, drafting and revising the article, final approval; EHM: analysis and interpretation of data, revising
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